Provider Demographics
NPI:1275849994
Name:SULLIVAN, JOANNA KATHLEEN (CNM)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:KATHLEEN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9340 SW BARNES RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6623
Mailing Address - Country:US
Mailing Address - Phone:503-215-2807
Mailing Address - Fax:503-215-2814
Practice Address - Street 1:9340 SW BARNES RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6623
Practice Address - Country:US
Practice Address - Phone:503-215-2807
Practice Address - Fax:503-215-2814
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201042058RN367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife